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Resistive inspiratory muscle training in people with spinal cord injury during inpatient rehabilitation: a randomized controlled trial
Postma K, Haisma JA, Hopman MTE, Bergen MP, Stam HJ, Bussmann JB
Physical Therapy 2014 Dec;94(12):1709-1719
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: People with spinal cord injury (SCI) may benefit from resistive inspiratory muscle training (RIMT). Current evidence is weak, and little is known about the effect on functional outcomes and long-term effects. OBJECTIVE: The purpose of this study was to assess immediate and long-term effects of RIMT in people with SCI. DESIGN: This was a single-blinded randomized controlled trial. SETTING: The study was conducted at 4 specialized SCI units in the Netherlands. PATIENTS: The study participants were 40 people with SCI (15 with motor complete tetraplegia, 16 with incomplete tetraplegia, 8 with motor complete paraplegia, and 1 with incomplete paraplegia) who had impaired pulmonary function and were admitted for initial inpatient rehabilitation. INTERVENTION: Study participants were randomized to an RIMT group or a control group. All participants received usual rehabilitation care. In addition, participants in the intervention group performed RIMT with a threshold trainer. MEASUREMENTS: Measurements were performed at baseline, after 8 weeks of intervention, 8 weeks later, and 1 year after discharge from inpatient rehabilitation. Primary outcome measures were: respiratory muscle function, lung volumes and flows, and perceived respiratory function. Secondary outcome measures concerned patient functioning, which included health-related quality of life, limitations in daily life due to respiratory problems, and respiratory complications. RESULTS: During the intervention period, maximum inspiratory pressure (MIP) improved more in the RIMT group than in the control group (11.7 cmH2O, 95% confidence interval 4.3 to 19.0). At follow-up, this effect was no longer significant. No effect on other primary or secondary outcome measures was found except for an immediate effect on mental health. LIMITATIONS: The sample size was insufficient to study effects on respiratory complications. CONCLUSIONS: Resistive inspiratory muscle training has a positive short-term effect on inspiratory muscle function in people with SCI who have impaired pulmonary function during inpatient rehabilitation.

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